Assessment of CSF HIV RNA, CSF HIV genotropism and genotyping of CSF HIV RNA. In subjects with detectable CSF HIV RNA, modifications to ART

should be based on plasma and CSF genotypic and genotropism results. Several published randomized controlled studies, assessing both intensification of ART with a new ARV agent [25] and with adjunctive therapies [26-29] have been published. Unfortunately, none of these studies describe improvements in cognition subsequent to the study interventions. Without evidence-based interventions, the Writing Group outlines below a best practice approach based on the current literature. As HIV-associated NC disorders are a diagnosis of exclusion, re-evaluation of subjects with ongoing NC impairment despite ART for confounding conditions, with expert input from other clinical specialties such as psychiatry,

Venetoclax concentration neurology and neuropsychology, is recommended and, where possible, input from an selleck inhibitor HIV neurology service. Assessment of CSF HIV RNA, CSF HIV genotropism and genotypic analysis of CSF RNA may be useful tools in the management of subjects with ongoing NC for the following reasons. First, data from cohorts of untreated HIV-positive subjects would suggest CSF HIV RNA to be greater in subjects with HIV-associated dementia and cognitive decline [30, 31] and therefore suppression of CSF HIV RNA may be beneficial for cognitive function. Secondly, in subjects with ongoing NC impairment, higher degrees of genetic diversity between HIV viral strains in the CSF and plasma compartment may exist [32], even in subjects with undetectable plasma HIV RNA [33]. Therefore, assessment for CSF HIV resistance may be worthwhile

to tailor ART. We recommend patients with HIVAN start ART immediately irrespective of CD4 cell count (1C). We recommend patients with end-stage kidney disease who are suitable candidates for renal transplantation start ART irrespective of CD4 cell count (1C). Proportion of patients with HIVAN started on ART within 2 weeks of diagnosis ever of CKD. The use of ART has been associated with a decline in the incidence of HIVAN in HIV cohort studies [1], with renal histological improvement in case reports [2, 3], and with delayed progression to end-stage kidney disease in case series [4, 5]. In the UK, most HIVAN cases are encountered in patients with advanced immunodeficiency who were not previously known to be HIV positive, or who disengaged from care or who declined ART [6]. HIVAN is rare in patients with CD4 cell counts >350 cells/μL or with undetectable HIV RNA levels [7].